Healthcare Provider Details

I. General information

NPI: 1609438977
Provider Name (Legal Business Name): GRAYSTONE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 18TH ST STE B
GULFPORT MS
39501-2911
US

IV. Provider business mailing address

2218 18TH ST STE B
GULFPORT MS
39501-2911
US

V. Phone/Fax

Practice location:
  • Phone: 401-300-4729
  • Fax:
Mailing address:
  • Phone: 401-300-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES PINKSTON II
Title or Position: CLINICIAN AND PARTNER
Credential: LCSW
Phone: 228-669-6278